Hindawi Publishing Corporation ISRN Geriatrics Volume 2013, Article ID 194693, 4 pages http://dx.doi.org/10.1155/2013/194693
Research Article Development of a Masticatory Indicator Using a Checklist of Chewable Food Items for the Community-Dwelling Elderly Hiroko Miura,1 Kayoko Sato,2 Shuichi Hara,3 Kiyoko Yamasaki,4 and Naoko Morisaki1, 5 1
Community Healthcare, National Institute of Public Health of Japan, Minami 2-3-6, Saitama, Wako-shi 351-0197, Japan Department of Health and Nutrition Sciences, Komazawa Women’s University, 238 Sakahama, Inagi-shi, Tokyo 206-8511, Japan 3 Faculty of Health Sciences, Kyushu University of Health and Welfare, 1714-1 Yoshino-cho, Miyazaki, Nobeoka-shi 882-8508, Japan 4 Faculty of Social Welfare, Kyushu University of Health and Welfare, 1714-1 Yoshino-cho, Miyazaki, Nobeoka-shi 882-8508, Japan 5 Faculty of Nursing Science, University of KinDAI Himeji, 2042-2 Oshio, Hyogo, Himeji-shi 671-0101, Japan 2
Correspondence should be addressed to Hiroko Miura;
[email protected] Received 27 November 2012; Accepted 12 December 2012 Academic Editors: D. Chan, A. Gentili, and D. Orsucci Copyright © 2013 Hiroko Miura et al. is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. e purpose of the present study was to develop a new assessment scale to evaluate masticatory ability among community-dwelling elderly individuals. e study comprised 761 independent elderly subjects residing in the community. We pooled 25 food items with various textures. Based upon the pass rate and nonresponse rate, we extracted 9 food items to be included in the masticatory ability assessment for the community-dwelling elderly (MACE). e reliability of this assessment was determined using Cronbach’s alpha coefficients. We then examined the concurrent validity of the MACE by comparing it with an existing method termed “mastication score.” Additionally, the convergent validity was examined by comparing the correlation coefficients of MACE, general oral health assessment index (GOHAI), and the number of teeth. Cronbach’s alpha coefficient of MACE was 0.89 (𝑃𝑃 𝑃 𝑃𝑃𝑃𝑃𝑃), indicating satisfactory reliability. MACE was signi�cantly correlated with the mastication score (𝑃𝑃 𝑃 𝑃𝑃𝑃𝑃𝑃), GOHAI (𝑃𝑃 𝑃 𝑃𝑃𝑃𝑃𝑃), and the number of teeth (𝑃𝑃 𝑃 𝑃𝑃𝑃𝑃𝑃). ese results suggest that MACE is a useful tool with sufficient reliability and validity to identify declines in masticatory ability among community-dwelling elderly individuals.
1. Introduction It is very important for middle-aged and elderly individuals in particular to maintain a healthy diet. Furthermore, for community-dwelling elderly persons, dietary insufficiency is adversely associated with overall health status [1, 2]. e digestive process begins with mastication, which is in�uenced by oral health status [3, 4]. Some cross-sectional studies report that chewing function is related to nutritional status, food selection, body composition (sarcopenia), and physical balance [5, 6]. In particular, poor mastication may contribute to restricted fruit and vegetable intake [7, 8]. e National Health and Nutrition Examination Survey of Japan indicated that 26.6% of Japanese people aged 60–69 years and 40.8% of Japanese people above 70 years of age had difficulty chewing [9] Interestingly, Bradbury et al. reported
that the combined approach of improved masticatory ability and provision of suitable nutritional guidance was effective in increasing fruit and vegetable intake among the elderly [10]. Improvement of masticatory status has been stated as a part of the Food and Nutrition Education (Shokuiku) by the Cabinet of Japan [11]. However, few assessments on the masticatory status of community-dwelling elderly individuals have been reported. In many epidemiological studies among community-dwelling elderly persons, subjective evaluation has frequently been used. us, the development of a more quantitative means of assessment will be needed for the community-dwelling elderly. e development of a simple and valid method to evaluate masticatory ability among community-dwelling elderly will allow us to provide better quality nutritional counseling based on oral health information.
2 Previously, evaluation of masticatory function has been performed using valid questionnaires for complete denture wearers at dental clinics [12, 13]. ese surveys provided satisfactorily reliable and valid results for denture wearers. However, there are few assessment tools for evaluating masticatory function for community-dwelling persons, including nondenture wearers. us, the purpose of the present study was to develop a new masticatory indicator for independent elderly individuals residing in the community, by using a checklist of chewable food items.
2. Subjects and Methods 2.1. Subjects. e present survey was conducted in the northern area of Miyazaki prefecture, Japan. e initial target population was 962 independent community-dwelling individuals aged 65–84 years. All potential subjects were contacted to explain the objectives of present study, and informed consent was subsequently obtained from 761 elderly persons (response rate: 78.1%; 342 men, 419 women; Average age: 71.2 ± 9.6). is study was approved by the Institutional Review Board of the National Institute of Public Health (NIPH-IBRA number 10050). 2.2. Study Design and Measurements. e study design was a cross-sectional survey. Survey items were grouped as follows: (i) demographic variables, (ii) oral health-related quality of life, (iii) clinical assessment of masticatory ability, (iv) the number of teeth, and (v) chewable food items. Oral health-related quality of life was evaluated using the Japanese version of the general oral health assessment index (GOHAI) [14]. Furthermore, clinical assessment of masticatory ability was conducted using the mastication score reported by Koshino et al. [12]. e number of teeth present was determined by oral examination. 2.3. Survey on Chewable Food Items. At �rst, we pooled 25 food items based on previous food-intake questionnaires [12, 13, 15], which evaluated masticatory ability in complete denture wearers (Table 1). We used a self-administered questionnaire to examine chewable food items using a 3-point Likert scale as follows: “0”: very difficult, “1”: slightly difficult, and “2”: easy. We also examined the rates of nonresponse and subjects who checked “easily masticated” (pass rate) for each food item in order to exclude unsuitable food items and maintain the divergent validity. Based on previous studies on scale development, the criteria of exclusion were as follows: nonresponse rate, more than 5%, and pass rate, more than 90% [16, 17]. 2.4. Analysis. Firstly, we excluded chewable food items according to the above exclusion criteria in order to set up the tentative masticatory checklist, which was termed the masticatory ability assessment for the community-dwelling elderly (MACE). Secondly, we examined the validity and reliability of MACE using statistical analysis. To verify the concurrent validity of MACE, we calculated the Spearman’s correlation coefficients (𝑟𝑟𝑠𝑠 ) between the score of MACE and
ISRN Geriatrics T 1: e pass rate and nonresponse rate for 25 chewable food items. Food item Banana Boiled cabbage Boiled carrots Boiled taro Boiled onion Strawberry Ham Boiled �sh paste patty Boiled seaweed Konjac food Fried chicken Roast chicken Apple Pickled eggplant Raw cabbage Roast pork Pickled radish Cubic rice cracker Peanuts Sliced raw cuttle�sh Raw carrots Vinegared octopus Dried cuttle�sh Dried sweet potato Hard baked rice cracker
Nonresponder (%)
Subjects passed (%)
0.9 0.5 0.9 1.0 2.7 2.3 5.0 1.8 3.2 0.5 2.3 10.0 1.0 1.2 1.2 9.1 0.9 4.1 2.7 8.2 2.3 16.4 8.2 4.5 3.2
97.3 90.9 96.4 97.8 95.0 97.7 98.7 93.6 90.0 92.3 80.0 75.4 85.5 85.9 86.9 80.9 80.0 78.6 70.0 70.9 63.2 68.2 49.5 59.5 62.7
the mastication score. We also examined the correlation between MACE and GOHAI, or the number of the present teeth, in order to verify the convergent validity. e reliability of MACE was examined using Cronbach’s alpha coefficients. ese serial statistical analyses were performed using SPSS version 19.0.
3. Results Table 1 shows the pass rate and the nonresponse rate for each item of the 25 food items. Following application of the exclusion criteria, 9 food items were included in the checklist for masticatory ability as MACE (Table 2). Figure 1 shows the score distribution of the MACE. Approximately 45% of the subjects had a perfect score with satisfactory mastication. e mean and standard deviation of the score was 14.2 ± 4.6, and the �rst, second, and third quartiles were 12.0, 16.0, and 18.0, respectively. Table 3 shows the correlations between the MACE and some variables such as mastication score, GOHAI, and the number of teeth. e MACE score was signi�cantly correlated with mastication score (𝑟𝑟𝑠𝑠 = 0.90, 𝑃𝑃 𝑃 𝑃𝑃𝑃𝑃𝑃). Furthermore, the MACE score had signi�cant coefficients
ISRN Geriatrics
3 350 300
Persons
250 200 150 100 50 0 2 3
4 5
6 7
8 9 10 11 12 13 Score of MACE
14 15
16 17
18
F 1: Distribution of the score calculated by MACE. T 2: e checklist related to masticatory ability∗ . Food item
Easy Fried chicken 2 Apple 2 Raw cabbage 2 Pickled radish 2 Cubic rice cracker 2 Peanuts 2 Raw carrot 2 Dried sweet potato 2 Hard baked rice cracker 2 ∗
Chewing status Slightly difficult Very difficult 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0 1 0
Cronbach’s alpha coefficient = 0.89 (𝑃𝑃 𝑃 𝑃𝑃𝑃𝑃𝑃).
T 3: Spearman’s correlation coefficients comparing MACE with GOHAI, the number of teeth, and mastication score. Versus the MACE score GOHAI Number of teeth Mastication score
𝑟𝑟𝑠𝑠
0.48 0.40 0.90
𝑃𝑃 value
